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Growing international consensus on Ambulatory Blood Pressure Monitoring

December 19, 2019

Recent comparisons of the American College of Cardiology (ACC)/American Heart Association (AHA) and European Society of Cardiology (ESC)/European Society of Hypertension (ESH) guidelines surrounding blood pressure demonstrates thinking around hypertension and ambulatory blood pressure monitoring (ABPM) is starting to align globally.

Both the ACC and ESC agreed ABPM should be used to confirm the diagnosis of hypertension, as results were more accurate for diagnostic purposes, but the groups differed slightly on the blood pressure threshold classifications for hypertension. (See more below)

Cardiac Monitoring Service CEO Rudy Watkins has welcomed the recent industry discussion, with hypertension remaining the leading cause of death worldwide and a primary risk factor for coronary artery disease.

“We’ve responded to the adoption of ambulatory blood pressure monitoring (ABPM) as the ‘gold standard’ when it comes to diagnosis and treatment of hypertension by introducing it as one of our core services.”

The ACC’s review of the guidelines follows a determination earlier this year by The Center of Medicare and Medicaid Services (CMS) to expand the definition of hypertension – which was adjusted from 140/90 to 130/90, to align with industry views.

The CMS also expanded their coverage policy of hypertension to include coverage for cases of suspected masked hypertension, as well as the existing coverage of white coat hypertension. According to the decision, in cases of both white coat and masked hypertension, ABPM would be covered once per year per patient.

Mr Watkins said that making ABPM more available to those who need it most is an important development. “Making ABPM more affordable and accessible means health professionals will not only be able to diagnose hypertension more effectively, but also track the effectiveness of treatment, meaning that cases of hypertension can be solved using quantitative data, rather than gut feel. It is believed 1 in 8 Americans suffer from masked hypertension, and this change in guidelines will help improve outcomes.”

­­In their ruling, the CMS outlined what an ABPM device must do:

Produce standardised plots of blood pressure for 24 hours, with daytime and night-time windows and normal blood pressure bands demarcated

Be provided to patients with both spoken and written instructions, as well as a test in the cardiologist’s office

Be interpreted by the treating cardiologist or treating non-cardiologist practitioner

Cardiac Monitoring Service’s ABPM device meets the determination’s requirements, as the device measures blood pressure at regular intervals (usually every 20-30 minutes) over a 24-hour period.

When complete, it allows you to prepare a report of the 24-hour, day time, night time, and sleep and awake (if recorded) average systolic and diastolic blood pressure and heart rate. The CMS’ determination is a great opportunity for cardiologists to expand their reporting methods, as well as the services they provide to patients, and will assist with more accurate and streamlined diagnoses of hypertension.

References:

View full ACC comparison of Guidelines

More on ACC/ESC review

Both the ACC and ESC agreed that ABPM should be used to measure blood pressure. They also recommended using a cardiovascular-risk calculator to determine blood pressure treatment thresholds, blood pressure treatment targets, lifestyle modifications as part of the treatment strategy and pharmacotherapy for blood pressure management.

However, there were still key differences in their guidelines. As the table shows, this was most apparent in the classification of hypertension, as well as blood pressure targets in adults over 65, drug treatment strategies and blood pressure targets in specific populations.

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